Provider Demographics
NPI:1003350281
Name:REDFERN HEALTH CENTER
Entity Type:Organization
Organization Name:REDFERN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DHA
Authorized Official - Phone:864-656-3564
Mailing Address - Street 1:735 MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-4054
Mailing Address - Country:US
Mailing Address - Phone:864-656-0692
Mailing Address - Fax:
Practice Address - Street 1:735 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29634-4054
Practice Address - Country:US
Practice Address - Phone:864-656-0692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEMSON UNVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-07
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1376503425261Q00000X
SC1720066053261Q00000X
SC1457329021261Q00000X
SC1225142961261Q00000X
SC1386871655261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center